What are the contraindications (risks) for a water immersion or birth for mother and baby?

*See BENEFITS/RISKS section in website.

How does the baby breathe if it is born into water?

There are 5 inhibitory factors that prevent a baby from inhaling water when born:

1. The baby in utero is oxygenated through the umbilical cord via the placenta. When a baby breathes air, the intercostal muscles and diaphragm move in a regular and rhythmic pattern. 24 to 48 hours before the onset of labor the prostaglandin E2 levels form the placenta cause a slowing down or stopping in the fetal breathing movements (FBM).(1) The diaphragm and intercostal muscles become suspended and there is a decrease in the FBM. At the birth, the baby's muscles for breathing simply don't work.

2. Babies are born experiencing acute hypoxia or lack of oxygen. This is built-in response to the birth process. Hypoxia causes apnea and swallowing, not breathing or gasping. If the fetus experienced severe and prolonged lack of oxygen, it may gas as soon as it was born, possibly inhaling water into the lungs. (2)

3. The temperature differential is another factor. When a baby is born into water so close to maternal temperature the baby doesn't detect a change so no breathing is initiated. In some places where an ocean birth occurs, the water is much cooler than maternal temperature. This is an area for reconsideration since lower temperatures do not seem to stimulate the baby to breathe while immersed either.

4. Water is a hypotonic solution and lung fluids present in the fetus are hypertonic. Hypertonic solutions are denser and prevent hypotonic solutions from merging or coming into their presence. Thus, as water passes through the larynx it does not pass into the lungs.

5. The 'mammalian dive or autonomic reflex' built into all newborns is present at birth and mysteriously disappears around 6 to 8 months. This reflex is associated with the taste buds along the larynx. When a solution hits the back of the throat and crosses the larynx, the taste buds interpret what substance it is and the glottis automatically closes: the solution is then swallowed, not inhaled.(3)

(*These five inhibitory factors are from Waterbirth Basics, From Newborn Breathing to Hospital Protocols by Barbara Harper, Midwifery Today with International Midwife, Summer 2000, Number 54. www.midwiferytoday.com)

It has been discovered newborns exposed to water training up to 8 months after birth are able to avoid atrophy of the mammalian dive reflex.

(Waterbirth and the Emergence of the Newborn, by Marina Alzugaray, CNM, Midwifery Today with International Midwife, Summer 2000, Number 54. www.midwiferytoday.com)